Lung Cancer Care in Victoria - ... Lung Cancer Optimal Care Pathway (OCP) 4 . Linked data sources Data

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  • Lung Cancer Care

    in Victoria

    Towards optimal care

    A/Prof Gavin Wright

  • Data analysis:

    CCV / DHHS

    Ella Stuart

    Dr Luc te Marvelde

    Lung Cancer 2019 Summit working party

    Chairs: A/Prof Gavin Wright Prof David Ball

    Members: Dr Andreas Baisch

    Mr Andrew Barling

    Dr Richard De Boer

    Mr David Deutscher

    Dr Wasek Faisal

    Prof Michael MacManus

    Prof Danielle Mazza

    A/Prof Paul Mitchell

    A/Prof Gary Richardson

    A/Prof Jeremy Ruben

    A/Prof Rob Stirling

    Dr Craig Underhill

    Mr Cheng-Hon Yap

    Dr Jackie Yoong

    Victorian Tumour Summits project team: Mirela Matthews

    Amy Sercombe

    Rebecca Miller

    Claire Porter

    2

    Aim:

    ● Discuss variations in care

    ● Victorian population perspective

    ● Variations in local approach

  • In this presentation

    ● Incidence and survival

    ● Lung cancer population at presentation

    ● Patterns of care & variation across

    Victoria:

    ○ Diagnosis, staging & treatment

    planning

    ○ Treatment

    ○ Palliative and supportive care

    3

  • Lung Cancer Optimal Care Pathway (OCP)

    4

  • Linked data sources

    Data linkage performed by The Centre for Victorian Data Linkage

    5

    Unlinked data sources

    Cancer Services

    Performance Indicator (CSPI)

    medical record audit 2017

    Victorian Lung Cancer

    Registry

  • ● Statewide data - reliable linkage program

    ● Population level outcomes - offers general indicative patterns

    ● Limitations:

    ○ Does not identify out of hospital care

    ○ Relies on hospital coding

    ○ Currently lacks specific disease features (e.g. staging)

    ○ Hume RICS – no surgery or chemotherapy data for

    patients treated in Albury (NSW)

    Features of the linked data set

    6

  • Integrated Cancer Services & Cancer Centres

    7

    GRICS

    GICS

  • Incidence, Demographics & Survival

  • Incidence

    Incidence

    Mortality

    Mortality Male

    Female

    Trends in incidence and mortality Victoria 1982 - 2016

    Source: Victorian Cancer Registry 9

  • Lung cancer 5-year relative survival is increasing

    Source: Victorian Cancer Registry 10

  • Demographics - linked dataset

    *Death Certificate Only (DCO) patients excluded (2008-2012 n = 602; 2013-2016 n = 417)

    **Excluding patients with no admissions between 2 years prior and 1 year after diagnosis.

    Source: Linked dataset - VCR, VAED 11

    Diagnosed 2008 - 2012

    N = 12,040*

    Diagnosed 2013 - 2016

    N = 10,797*

    Male, N (%) 7,170 (60%) 6,154 (57%)

    Age (median) 72 72

    SES quintile 1 (most disadvantaged), N (%) 3,668 (31%) 3,167 (30%)

    Ever smoked, N (%)**

    (VAED derived, 2 years prior to 1 year after

    diagnosis)

    9,798 (81%) 8,914 (83%)

    No hospital admissions, N (%)

    (VAED, 30 days prior to 1 year after dx date)

    274 (2%) 171 (2%)

  • Tumour characteristics – linked dataset

    *Excluding patients with no admissions between 30 days prior and 4 months after diagnosis.

    Source: Linked dataset - VCR, VAED 12

    Diagnosed 2008 - 2012

    N = 12,040

    Diagnosed 2013 - 2016

    N = 10,797

    Morphology:

    NSCLC

    SCLC

    Carcinoid

    Other

    10,509 (87%)

    1,296 (11%)

    206 (2%)

    29 (

  • 13

    Proportion of lung cancer patients who had metastatic disease at diagnosis by ICS (2008 - 2016) (N = 22,837)

    Source: Linked dataset - VCR, VAED. *HRICS data limitation. ** Excluding HRICS.

    Pearson’s 𝝌²**: 2008-2012 P = 0.017

    2013-2016 P = 0.158

    *

  • Absolute survival time by ICS of residence (metro vs regional) and diagnosis year (2008 - 2016) (N = 22,837)

    14 Source: Linked dataset - VCR

    Logrank test for difference

    between metro and regional:

    2008-2012 P < 0.001

    2013-2016 P = 0.005

    2008-2012 Metro

    1 year - 43.6% (95% CI 42.5-44.7)

    4 year - 19.2% (95% CI 18.3 - 20.1)

    2008-2012 Regional

    1 year - 40.3% (95% CI 38.9 - 41.9)

    4 year - 16.4% (95% CI 15.3 - 17.6)

    2013-2016 Metro

    1 year - 48.1% (95% CI 47.0-49.3)

    4 year - 23.7% (95% CI 22.5 - 24.9)

    2013-2016 Regional

    1 year - 46.2% (95% CI 44.6 - 47.9)

    4 year - 20.8% (95% CI 19.2-22.6)

  • Tissue Diagnosis

    15

  • Lung cancer with tissue diagnosis by year of diagnosis (2008 - 2016) (N = 22,483)

    16

    Pearson’s 𝝌²: P < 0.001

    Test of trend:

    P < 0.001

    Excluding ‘unknown’ (n=354).

    Source: Linked dataset - VCR

  • Lung cancer with tissue diagnosis by age group (2008 - 2016) (N = 22,483)

    17 Excluding ‘unknown’ (n=354). Source: Linked dataset - VCR

    Pearson’s 𝝌²: 2008-2012 P

  • Age-adjusted tissue diagnosis by ICS of residence (2008 - 2016) (N = 22,483)

    18 Adjusted for age. Excluding ‘unknown’ (n=354).

    Source: Linked dataset - VCR

    2008 - 2012 2013 - 2016

  • Multidisciplinary Treatment Planning and Discussion

  • Victorian Lung Cancer MDMs

    20

  • Documented multidisciplinary team meeting in the patient’s central medical record (2017) (N = 324)

    21

    Source: CSPI medical record audit 2017.Bars represent 95% CI.

    Data limitation - The CSPI audit includes 28 public hospitals and 4 private hospitals.*HRICS data limitation.

    Lung Cancer

    Summit 2014

    Victorian average

    (2011-2013) = 62%

    * P

  • Proportion of patients with documented evidence of communication of initial treatment plan to GP

    (2017) (N = 324)

    22 Source: CSPI medical record audit 2017; Bars represent 95% CI. Data limitation - The CSPI audit includes 28 public hospitals and 4 private hospitals.*HRICS data limitation.

    Pearson’s 𝝌²: P < 0.001

    *

  • Timeliness to Treatment

  • Time from diagnosis to first treatment - surgery for non- metastatic NSCLC (2013 - 2016) (N = 1,846)

    24 Major surgery - lobectomy, pneumonectomy and sublobar resection. Source: Linked dataset - VCR, VAED, VRMDS 2013-2016

    Overall 61% (1,129/1,846) of

    NSCLC patients underwent surgery

    within 14 days of diagnosis.

    Variable Level Surgery within

    14 days (%) P-value

    Patient

    Residence >

    Treatment

    Location

    Regional > Regional 51

    Metro 60

    Metro > Metro 64

    Diagnosis Year

    2013 57

    0.096

    (trend)

    2014 60

    2015 66

    2016 61

  • Surgery for NSCLC – Access and Survival

  • Adjusted odds of having surgery for non-metastatic NSCLC by ICS of residence (2013 - 2016) (N = 4,816)

    26

    Model adjusted for age and comorbidities. Bars represent 95% CI.

    Surgery (lobectomy, pneumonectomy, sublobar resection) within 6 months of diagnosis.

    Source: Linked dataset - VCR, VAED 2013-2016. *HRICS data limitation.

    ← Less likely More likely →

    *

  • Survival for non-metastatic NSCLC by ICS of residence (2013-2016) (n = 4,816)

    27 Adjusted for age, sex, comorbidities and diagnosis year. Bars represent 95% CI. Victorian average = 1.0.

    Source: Linked dataset - VCR, VAED.

    IC S

    o f re

    s id

    e n c e

  • Survival for metastatic NSCLC by ICS of residence (2013-2016) (n = 4,596)

    28 Adjusted for age, sex, comorbidities and diagnosis year. Bars represent 95% CI. Victorian average = 1.0.

    Source: Linked dataset - VCR, VAED.

    IC S

    o f re

    s id

    e n

    c e

  • 29

    Surgery (lobectomy, pneumonectomy, sublobar resection) within 6 months of diagnosis.

    Model adjusted for age, sex, comorbidities and diagnosis year. Bars represent 95% CI. Victorian average = 1.0.

    Source: Linked dataset – VCR, VAED.

    Survival for non-metastatic NSCLC by ICS of residence (2013 - 2016)

    Surgical patients (n =1,876) Non surgical patients (n =2,940)

    ← Better survival Poorer survival → ← Better survival Poorer survival →

  • Non-metastatic NSCLC patient flow for surgery

    (2013 - 2016) (N = 1,876)

    30

    ICS of

    residence

    ICS of surgery campus

    SMICS WCMICS NEMICS GRICS BSWRICS HRICS** LMICS GICS Total

    SMICS 434 (87%) 35 (7%) 30 (6%) 2 (0%) 501 (10